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Our Approach: Rebuilding Health and Social Care Services in Belfast Trust

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Our Approach: Rebuilding Health and Social Care Services in Belfast Trust Our Approach: Rebuilding Health and Social Care Services in Belfast Trust April - June 2021 Service Rebuild Plan 2 Section1: Introduction Our Trust experience during COVID-19 During the pandemic, our priority in Belfast Trust has been the continued safety of our patients, service users and staff, while supporting our carers and families. Our commitment remains to recognise and respond to the health and social care priorities across our local community and across the region, delivering the right care in the right place at the right time, and supporting our staff who have continued to show tremendous resilience and creativity during this testing period. Across the Trust, and since the start of the pandemic, our staff worked tirelessly to sustain services as far as possible, during the COVID-19 surge. We remain indebted to them for the resilience and dedication they have displayed throughout. We are committed to continue to work in partnership with Staff and Trade Unions in supporting our staff recovery from the pandemic. This plan is for those services that experienced a significant impact as a result of the pandemic and explains the actions being proposed to further increase capacity and/or access from April 2021. Since March 2020, COVID-19 has had a significant impact on health and social care provision across BelfastTrust when many services had to suspend or reduce normal service including many elective procedures. In July 2020, Belfast Trust implemented rebuild plans agreed with the Health and Social Care Board (HSCB) and in collaboration with other Trusts. We were able to maintain progress on rebuilding services during the second surge of COVID-19. Due to the scale of the third surge, the Trust had to undertake actions as outlined in its Winter Resilience plan, often at short notice, to ensure that patient, service user and staff safety remained our priority as demonstrated in Figure 1. Figure 1: Trust response to COVID since March 2020 COVID-19 Phase 1 Phase 2 Phase 3 Winter Rebuild Plan March 2020 Rebuild Plan Rebuild Plan Resilience Plan April - June 2021 June 2020 September 2020 December 2020 The Trust is committed to providing a carefully considered, balanced and evidence-based response according to the levels of the pandemic and to re-introducing services when it is safe to do so. We have also learnt from experience and engagement over the last year and developed innovative ways to deliver services and facilitate health and social care. The Trust acknowledges the long term health and psychological impacts of COVID. We will work with regional colleagues to ensure appropriate services are in place. 3 From December 2020, we have successfully delivered vaccines to our staff and members of our community from Belfast and across the region. The Trust will continue to support the vaccination programme, including the continued redeployment of staff, which will impact on rebuild plans in some service areas. The Northern Ireland Executive has now published its Pathway Out of Restrictions to illustrate the way forward for the people of Northern Ireland. However, it is important to acknowledge that we will continue to live with COVID-19 for some time and this will continue to impact on how we can deliver our services, including social distancing and infection prevention control measures. Figure 2: COVID Impact in Hospital and Critical Care Admissions with Covid-19 ICU Admissions with Covid-19 700 80 600 70 60 500 50 400 40 300 Admissions Admissions ICU Admissions 30 200 20 ICU Admiss ions 100 10 0 0 03/20 04/20 05/20 06/20 07/20 08/20 09/20 10/20 11/20 12/20 01/21 02/21 03/20 04/20 05/20 06/20 07/20 08/20 09/20 10/20 11/20 12/20 01/21 02/21 Inpatient Admissions (as at 28th Feb 21) Critical Care • 2,467 admissions due to Covid-19 • 207 admissions to Critical Care (8% of patients admitted) • 2,045 were discharged (91%) • 145 were discharged (70%) • 370 patients died (9%) • 33 patients died (16%) • 52 remain in hospital (<1%) • 29 remain in hospital (14%) Demand on Beds Demand on Beds • Covid-19 patients used 26,519 bed days in general wards • Covid-19 patients used 3,351 bed days in Critical Care Key Principles adopted when developing the Rebuild plan The Trust has set out in this document, a high-level overview of the services that we plan to maintain and rebuild during April to June 2021. We remain committed to delivering safe effective and compassionate care for all our clients and patients and the focus will be on treating the most urgent cases first. As a result, some patients may continue to wait longer than we would like. In accordance with the Regional Rebuilding Management Board, chaired by the Department of Health Permanent Secretary, the process of rebuild will be guided by the following five principles: • Principle 1: We de-escalate Intensive Care provision as a region, informed by demand modelling and staffing availability; • Principle 2: Staff are afforded an opportunity to take annual leave before assuming ‘normal’ duties; • Principle 3: Elective Care rebuild must reflect regional prioritisation to ensure that those most in clinical need, regardless of place of residence, are prioritised (short notice cancellations may result in the scheduling of routine patients to avoid the loss of theatre capacity); • Principle 4: All Trusts should seek to develop green pathways and schedule theatre lists 2-3 weeks in advance. The aim will be, for any given 4 staffing availability, to maximise theatre throughput; • Principle 5: The Nightingale facilities should be prioritised for de-escalation to increase regional complex surgery capacity as quickly as possible. As well as these principles, we will continue to work together with our partners across Northern Ireland to implement the recovery of Non–COVID-19 Health and Social Care Services and will contribute to the regional work streams/areas of focus to support the Health and Social Care (HSC) sector in delivering for our population - based on our agreed regional approach: • To ensure Equity of Access for the treatment of patients across Northern Ireland; • To minimise transmission of COVID-19; and • To protect access to the most urgent services for our population. In addition, regional rebuild groups are working to outline likely rebuild developments over this period, which are informing the Trust Rebuild plans. These include Critical Care De-escalation, Cancer Services, Regional Waiting List, Orthopaedic Hubs, Day Case Elective Care, No More Silos, Vaccine Programme, Mental Health and Adult Social Care. Please see Section 2 for further details. The Trust is committed to its legal duties under Section 75 of the Northern Ireland Act 1998 as detailed in its approved Equality Scheme and the Rural Needs Act 2016. We will screen for both equality and rurality impacts with mitigation measures introduced when potential adverse impacts are identified as appropriate. Belfast Trust Rebuild Service Plan Apr-June 21 Equality Screening Some of the Key Challenges in implementing our plans: • Balancing safety and risk through regional agreements. We must ensure both an effective ongoing response to COVID-19 locally and the need to rebuild elective surgical and diagnostic services for prioritised clinical groups on an equitable basis for the Northern Ireland population, taking account of specific Trust differences for example available accommodation; • Assessing workforce pressures including the ability to safely and appropriately staff the rebuild plans. We must ensure our staff are supported and feel valued by providing staff who were redeployed to ICU and other areas time to recover. Over the last year staff have been working relentlessly and have not been able to take sufficient periods of annual leave, therefore it is important to give them the opportunity to avail of annual leave before they return to their roles. We also need to ensure that we can staff the vaccination programme, manage local cluster outbreaks and enable flexible working necessary to support childcare and caring commitments; • Building on new ways of working and innovations to provide safe and effective care. Recognising the widespread adoption of telephone triage, virtual clinics and video calls during COVID-19, we will continue to work innovatively with our Primary Care/Community partners and our clinical leaders to maximise the rapid scaling of technology; • Continuing to maintain effective COVID-19 zoning plans in line with Infection Prevention and Control (IPC) advice and guidance, to safely manage separate pathways for the flow of staff and patients across all sites, optimise efficient utilisation of Personal and Protective Equipment (PPE) and ensure adequate catering and rest facilities for our staff; • Assessing the ability of our accommodation and transport infrastructure to support and enable restart plans across our hospital and community sites; 5 • Sustaining models for ‘swabbing’ and ‘testing’ of health care workers and patients/clients as part of our ongoing response to COVID-19; • Sustaining a reliable supply of critical PPE, blood products and medicines to enable us to safely increase our services. In this plan the Trust has assumed a supply of PPE to meet the anticipated activity levels; • Providing necessary support and resources to the nursing/ care home sector on an ongoing basis alongside the successful rebuild of Trust based services; • We will be mindful of our commitment to co-production and engagement and informed involvement in key decision making in our local agreements to rebuild plans, while also harnessing opportunities to deliver services differently with innovative solutions and aligned to our social distancing commitments and need to deliver safe and effective health and social care services; • Providing continued support to those in need within our population including those who were ‘shielding’, vulnerable people, and people at risk of harm.
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